One Woman's Journey To Help Women Post-Pregnancy.
“I’ve created a company that truly advocates for [people]. It’s not just a blurb on my website.”
- Tamoiya Ragsdale-Hashim, doula and business owner.
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Tamoyia Ragsdale-Hashim, a long-time birth advocate and doula, has designed a business, partly, to address the needs of women in DC, Maryland, and Virginia who struggle with mental health issues during the postpartum period.
Rise And Birth Postpartum, Ragsdale-Hashim’s organization, provides educational labor practices, birth care, advocacy, postpartum care, and consulting for women. The organization contracts with 9 women, who have a range of professional expertise. These birth and children specialists help families learn how to sleep healthily, assist women with pelvic floor pain, and breastfeeding. However, what makes the company unique is that they offer a full year of postpartum care, helps parents transition children to toddlerhood, provide information about maternal mental health, and help local doulas to discern the signs of postpartum depression and suicide.
Ragsdale-Hashim believes that women, and families as a whole, need wrap-around services during the postpartum period (also known as the post-birth period), a vulnerable time for women. Women sometimes receive little to no care for their mental health during this time. For this reason, postpartum depression sometimes goes undetected.
But it’s not only that women receive little to no care for their mental health problems. Sometimes it’s hard for women to tell if they are suffering from a mental health crisis because it is normal for them to have mood swings, irritability, sadness, feeling overwhelmed, appetite problems, and sometimes insomnia during the postpartum period. It is often referred to as the “postpartum blues.” According to the Cleveland Mayo Clinic, about 50 to 75 percent of women have this experience.
“Where we get concerned is when women are continuing to experience irritability, anxiety, and a lack of interest in pleasurable activities. ”
“Women can be very tearful after giving birth,” said Dr. Carla Sandy, an OBGYN at Kaiser Permanente in Silver Spring, Maryland. “When I talk to women, they say I cry so easily after delivery. All that usually lasts about two weeks.”
However, women shouldn’t feel like this beyond two weeks. According to Dr. Sandy, beyond two weeks, these symptoms should subside. She said women may still have physical pain, but not negative moods.
“Where we get concerned is when women are continuing to experience irritability, anxiety, and a lack of interest in pleasurable activities,” Dr. Sandy explained.
Ragsdale-Hashim feels there is a lack of understanding about maternal mental health and maternal mortality. Recent data shows the maternal mortality rate during the pandemic has increased, especially among Black and Latino women. Between 2006-17, suicidal thoughts and harm nearly tripled among childbearing women, according to research.
“I’ve created a company that truly advocates for [people],” said Ragsdale-Hashim, who has a certification in perinatal mental health from Postpartum Support International. “It’s not just a blurb on my website.”
Ragsdale-Hashim’s educational background – coupled with a negative birthing experience, which resulted in a mental health crisis – has helped her to discern that women have few resources to address postpartum depression.
“I just saw such a lack of resources, even from within maternal practices that considered themselves ‘centered’ in maternal mental health,” said Ragsdale-Hashim, a Shiite Muslim and Prince George’s County resident. “Because it's really hard to know the signs. I had a classic case of psychosis and depression.”
Disappointment And Darkness
Some years ago, Ragsdale-Hashim was pregnant with her third child. At 20 weeks, during an ultrasound, doctors found that she had a complete placenta previa, an abnormality that occurs when the baby’s placenta completely or partially covers the cervix. This can result in bleeding either throughout the pregnancy, during birth, or after birth. According to the Mayo Clinic, “changes in the uterus and placenta during pregnancy may lead to the problem correcting on its own. If it doesn't, the baby is delivered by cesarean (C-section).”
Her condition didn’t cause her to bleed throughout her pregnancy. To ensure the safety of herself and the baby, doctors required a C-section at a medical facility. Because birthing midwives and doulas, cannot perform C-sections, she could no longer give birth at the Special Beginnings Birth & Women’s Center, which is now closed, in Maryland.
According to Ragsdale-Hashim, they weren’t prepared for what would come next. They did not know that excessive bleeding post-birth could lead to the removal of her uterus. She said doctors failed to inform her that this was a possibility.
“I went in for a c-section because I had an issue with my placenta [previa] and I woke up with no uterus.”
“I had no idea of those things,” said Ragsdale-Hashim. “I didn't even know that was even possible. You know, it wasn't something that I was thinking about.”
During a routine hospital visit, doctors discovered that she was anemic, but Ragsdale-Hashim said, neither she nor her husband was informed. Since anemia has to do with iron deficiency, doctors advise clients to take a supplement or to add iron-heavy foods to their diets to increase iron. Being anemic meant that her chances of hemorrhaging would significantly increase. It also meant that she would hemorrhage whether she had a vaginal or cesarean birth. “I was not given the opportunity to fix my blood levels,” said Ragsdale-Hashim.
According to Ragsdale-Hashim, she discovered she was anemic about 6 to 8 weeks post-birth. “I didn't find out until I asked for...my lab reports,” she explained.
During C-sections, patients are given anesthesia to numb the lower portion of a mother’s body. Ragsdale-Hashim said the C-section was successful. Doctors removed her daughter from her abdomen, and –as she remembers –nurses gave her the child. With her present, she held her daughter on her chest. “Her vitals were good,”Ragsdale-Hashim remembers.
While she was bonding with her child – she began to excessively bleed. “I can only remember feeling very tired and asking someone to take the baby off of my chest. That’s the last thing I remember. I blacked out.”
Due to the bleeding, doctors had to perform a surgical procedure to remove her uterus.
“I went in for a C-section because I had an issue with my placenta [previa] and I woke up with no uterus,” Ragsdale-Hashim lamented.
Jenifer Lanore is a perinantal therapist, clinical social worker, and doula. Photo is from her LinkedIn profile.
Jenifer Lanore, a certified clinical social worker, therapist, and doula, has a similar story to Ragsdale-Hashim. Lanore has had two traumatic birth experiences that resulted in postpartum depression and anxiety. She said women can consider a negative birth to be many things. Negative birth experiences can consist of women hoping to have a vaginal birth, but instead having a cesarean; or wanting to have an unmedicated birth, but instead of an epidural. Furthermore, it could be that the medical team failed to care for the patient, making them feel alone and confused.
“It's important that we validate and recognize those negative experiences,” explained Lanore, who has a certification in perinatal mental health. “If that person says it was traumatic, bottom line, it was. “We don't try to define that for them.”
Our bodies, Lanore said, including our minds, keep track of traumatic experiences. Those experiences, when left unprocessed, she said, “can kind of come up at any point and time.”
“[It can manifest] through depression or through anxiety,” she explained.
Ragsdale-Hashim being uninformed about her body, and waking up with no uterus, was painful. Her mental health began to decline afterward.
She became delusional. Inwardly, she was blanketed by this paralyzing fear that someone had swapped her child for another at birth. Sometimes, she believed that her newborn daughter wasn’t the one she carried within her body for nine months.
Earlier in life, she struggled with an eating disorder, and now she was using food to cope with her pain. She started seeing a therapist. She said her first therapist told her that as long as she wasn’t using drugs to cope, she was OK. She found that to be unhelpful and canceled her future appointments. Furthermore, she was struggling while still having to homeschool her other two children, feed her baby, and run a business.
Publicly, she kept smiling to stave off a racialized stigma of not being a capable Black woman and parent. She wanted to appear as if her body and mind hadn’t drifted apart.
“These were the things that I was going through,” she said.“If I had someone with me or close to me that knew how to ask me the right questions about my mental health, then…I could have gotten the help I needed.”
Through all of this, Ragsdale-Hashim held on to her Islamic faith. She said in Islam, mothering is very important. She said her faith acknowledges the hardship of mothering. It’s because of this, that a woman has honor and dignity in the household and in the community. Though she questioned God about her circumstance, she held on to her faith. This perspective helped her to continue on even when the darkness encircled her.
“This was bad, but I felt grounded…within my faith,” said Ragsdale-Hashim. “I felt seen in this. I knew that I would be navigated through because of my faith.”
Care in the Post-Birth Life
Another possible reason why postpartum depression goes unchecked is that women, especially women of color, aren’t often screened for depression during the postpartum period, according to many studies. “I wasn’t screened at all for depression after giving birth,” said Ragsdale-Hashim.
“Often, people will say, ‘Be the Change You Want To See.’ Well, Ragsdale-Hashim is the change she wants to see in the doula field. ”
“If care providers don't have a standardized approach to depressive screening, you run the risk of excluding women because then you're picking who to screen,” explained Dr. Sandy of Kaiser. “When you're picking who to screen, you're going to miss people.”
There are other reasons why women may go unscreened for depression during the postpartum period. Women sometimes have a hard time telling others about how they feel. (Ragsdale-Hashim stated that she felt like she had to power through it). Also, in some communities of color, acknowledging that you're having a mental health problem may be considered a sign of weakness, which may not garner support.
“You may not necessarily have the support of your community, you know, to say ‘Hey, I'm not really doing that well mentally,’” said Dr. Sandy. “And so if you're talking to your midwives, your obstetrician, and they're asking you questions, it may not be your first instinct to say something.”
Dr. Sandy endorses a universal screening method that would “eliminate the chance that you’ll miss someone because you are picking who to screen.” Sandy said they have found that if you have people fill out a questionnaire, one with a scoring rubric, they are more forthcoming. The rubric will show if depression is present. Patients seeing their scores may prompt them to be more accepting of getting the care they need.
Dr. Sandy believes in a multilayered approach to dealing with post-postpartum depression. She said not only do women need therapy, but they also need a community, one where women can go to share their pain. They also need medication. Furthermore, she believes the U.S. needs a paid family leave bill, one that would give all women the time they need to heal mentally and emotionally post-birth.
Ragsdale-Hashim recommends, if possible, getting a therapist that is competent in perinatal mood and anxiety disorders. Getting the proper help you need, Ragsdale-Hashim and Lanore say, is essential to getting well.
Often, people will say, “Be The Change You Want To See.” Well, Ragsdale-Hashim is the change she wants to see in the doula field. She said she understands how hard postpartum life for families can be. It is for this reason that Ragsdale-Hashim’s business model is people-centered, one that can offer clients a path to healing.
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